TAIPEI, TAIWAN (UroToday.com) - Traditionally, percutaneous nephrolithotomies have been performed under general anesthesia (GA), however older patients with significant comorbidities do not tolerate GA very well. Contraindications in these patients do not allow performing the procedure under GA. Dr. Rasyid’s group evaluated the safety and efficacy of spinal anesthesia (SA) for PCNL procedures.
In the GA group, PCNL was performed using standard technique under general anesthesia. Dr. Rasyid nicely described the technique of S A. The authors use 22 gauge needles most commonly and 25-27 gauge needles when indicated in younger patients. The SA was performed by injecting bupivacaine and fentanyl in spinal space L4 with the patient in a sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the bed was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique.
Interestingly, SA was used more often in patient who had previous surgery (65,5%) compared with general anesthesia (36%). The average OR time for the GA group was significantly longer that the SA group, which is the main benefit of having patients under SA. In addition, the mean hospital stay was again shorter in the group of patients who underwent the procedure under SA. Most importantly, there was no difference in the number of complications and transfusions between the two groups.
In conclusion, SA is a feasible anesthesia option for PCNL procedures and it's a surgeon’s preference to use it when there are contraindications for traditional general anesthesia.
Presented by Nur Rasyid, Ponco Birowo, Ari Astram, Pryambodho P, and Susilo Candra at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Departement of Urology, Cipto Mangunkusumo Hospital/ Faculty of Medcine, Universitas Indonesia
Written by Zhamshid Okhunov, MD, Department of Urology, School of Medicine, University of California-Irvine, and medical writer for UroToday.com